Primary care, on the verge of collapse

Anyone who has contacted their primary care center in recent months will have come across a bleak picture: telephone waits when it comes to making appointments, consultations that are granted for weeks or months after the request and some toilets to the limit of his powers. Primary care, essential for the proper functioning of a country's health system, is on the verge of collapse in Spain, as evidenced by reports from the Ministry of Health itself.

The workload has increased by an average of 23.51% during the pandemic: in 2021, the health workers attended, in their ordinary activity, 453,023,901 consultations compared to 366,762,404 in 2019, according to data from the Information System of Primary Care (SIAP). This growth in the number of tasks has not meant, on the other hand, a reinforcement of the templates; on the contrary, it has been assumed by decimated teams and subjected to more and more pressure. In 2021 there were 136 fewer family doctors in Spain than in 2021 (29,601 compared to 29,727) and 28 fewer paediatricians (6,474 compared to 6,502). And casualties due to covid or anxiety or depression have ended up destroying any attempt to reach all the patients who requested a consultation. «The data is not real, it is worse, because the staff has never been complete.

In fact, primary care doctors have had an average of 40% more work during the pandemic," says Lorenzo Armenteros, spokesperson for the Spanish Society of General and Family Physicians (SEMG). In this situation, he explains, "there are many difficulties in doing the job well." «The professionals were burned and also, we work with patients who were also burned because they feel that they were not being treated well. The panorama is dramatic, ”says this doctor, who does not believe that the situation, at least in the short term, will improve. “We are seeing how now there are many patients who return to attend consultations in person because they need affection and see their doctor again. The workload continues to be above 40% of what it was before the pandemic.”

The most affected sector, nursing

According to data from the Ministry of Health, even above doctors, the group most affected by the saturation of primary care during the pandemic has been nursing. In these two years there were only 395 more nurses (from 30,537 to 30,932), but in 2021 they had to take on the enormous task of vaccinating the entire Spanish population with two doses. That year they gave 84 million vaccines against covid, which explains why they went from attending 132 million consultations in 2019 to 190 million two years later. Thus, their volume of work increased by 44%. Precarious conditions Part of the staff moved to vaccination and those who stayed were forced to put aside many of the tasks they did before the pandemic, also working in precarious conditions.

“I have been to six different health centers,” explains Silvia Fernández, a 27-year-old nurse from the Community of Madrid. She attended by phone, in person and at home, in days that she knew when they began, but not when they ended. "In the morning you arrived at your post thinking: 'What am I going to find today,'" she recalls. The protocols changed almost every day and so did the tasks performed by the nurses. “We treated respiratory patients, carried out diagnostic tests and vaccinated people who could not move at home. It was very stressful and the vocation and fellowship of those days saved us, but around me I have seen many toilets break down », says Fernández.

depression or insomnia

33% of nurses acknowledged having suffered depression during the pandemic, 58%, insomnia, and 67.5%, severe episodes of anxiety, according to a macro-survey carried out by the General Nursing Council with 19,000 professionals. “There are different factors that come together to create a perfect storm. Primary care has already collapsed and there are people who do not realize it. In Spain, 95,000 more nurses would be needed just to reach the European average," says Florentino Pérez Raya, President of the Council.

A week ago, Carolina Darias announced that the General State Budget would finance an infrastructure and equipment plan for primary care endowed with 434 million euros with the aim of improving diagnostic capacity and reducing temporality. “A large investment is necessary. Right now, it is not possible to offer the Spanish population, aged and suffering from chronic pathologies, the care they require.

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